Latest Treatment of Toothache

Steel Bite Protocol

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Steel Bite Protocol Summary


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Author: Thomas Spear
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Dentists Be Damned

This eBook teaches you all the remedies and tricks that you need to know to Never visit the dentist again, and still have the most perfect mouth full of the teeth that you know of. This book contains a toothache remedy that will treat the root of the problem, how to restore your gums to full health, a supplement that makes plaque fall off your teeth in no time, and a solution that can stop cavities Forever. This book doesn't just teach you how to get rid of some pain, it teaches you how to Eliminate the source of pain once and for all. After taking to heart the information in this book, trips to the dentist will become a thing of the past. Alice Barnes has taken her 15 years of tooth research and compiled it all in this eBook for you. And when you order, you get two free eBooks! You will also receive How to Prevent and Cure Canker Sores, and How to Get Rid of Bad Breath. All of these resources will keep you OUT of dentists' offices as long as you live! Continue reading...

Dentists Be Damned Summary

Contents: Ebook
Author: Alice Barnes
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Price: $47.00

Acute Pain The Dental Pain Model

There are a number of situations in which patients experience acute pain. The post third molar extraction dental pain model is a useful model for the study of analgesia of acute pain. As described by Averbuch and Katzper 44 , the model is relatively easy to study and there are few confounding factors. The dental pain studies are conducted in subjects scheduled to have their third molars removed. To be included in analysis, the subjects must experience moderate to severe pain following the extraction procedure. The study drug is administered after the pain assessment. Subjects can receive a local anesthetic, intravenous sedative agents, or antianxiety agents during the surgery however, subjects cannot receive any analgesic for 24 hours prior to study. The efficacy endpoints include pain intensity score measured by a 4-point categorical scale (from 0 none to 3 severe) and pain relief score measured by a 5-point categorical scale (from 0 no relief to 4 complete relief). The scores are...

Early childhood caries

Killian Clarke 1924 Dental Caries

Dental caries is one of the most prevalent diseases affecting people in industrialized countries. Caries of enamel surfaces (enamel caries) is particularly common in children (ECC) and young subjects up to the age of 20 years, while root surface caries is frequently observed in elder individuals with gingival recession exposing the vulnerable cementum to microbial colonization (Fig. 1) 3 . The first description regarding the association of Streptococcus mutans with human caries was made by Clarke in 1924 4 , and numerous studies have been performed to elucidate the causative relationship between specific oral bacterial species and dental caries. In animal experiments including monkeys, gerbils, mice, rats and hamsters, most studies indicated the cario-genicity and the transmissibility of mutans streptococci, although organisms other than mutans streptococci occasionally induce variable levels of dental caries in animals 2 . In humans, many epidemiological surveys have also found a...

Toothpaste for Sensitive Teeth

Some toothpaste are meant to help prevent pain in teeth sensitive to heat, cold, and pressure. Sensitive teeth are usually the result of recession of the gums, which has led to expose tooth roots. Because the roots are not protected by enamel, the small channels leading to the pulp of the tooth are vulnerable to environmental factors like heat and cold. Toothpaste formulations geared for sensitive teeth work by either deadening nerve endings or making teeth less porous. Active ingredients commonly used to block access to the tooth root include fluoride and either potassium nitrate or strontium chloride. Most toothpastes for sensitive teeth contain about 5 potassium nitrate or strontium chloride. The ingredients work with minerals present in saliva to crystallize and cover the pores in teeth, blocking entry to the roots. Results should be apparent after several weeks of using an OTC toothpaste for sensitive teeth.

Oral Health

Diabetes adversely affects oral health, increasing the risk of gingivitis and other oral infections. Gingivitis is a major cause of tooth loss and pain that can affect oral intake. Saliva flow protects against dental caries but age, drugs and diseases can reduce this. Poor oral and dental health is linked with chewing difficulties that can cause malnutrition, poor general health and reduced quality of life (45,46). Population changes in oral health and dentition over the last 30 years have resulted in fewer older people with no natural teeth - declining from 37 in 1968 to 12 in 1998 and predicted to fall to around 2 by 2018 (47). There are dietary implications for those with no teeth or partial dentures, as difficulties in eating can lead to a reduction in the variety of food choices and an overall reduction in nutrient intake. A 15 drop in energy intake has been reported in free-living elderly people without any natural teeth. Full dentures, in particular, can lead to a reduction in...

Caries and Sugar

Dental caries is a disease created by bacterial plaque on the enamel of teeth. Gradual and progressive demineralization of the enamel, dentine, and cementum occurs. Many studies have suggested that carbohydrates, especially sugars and in particular sucrose, are important carie-promoting components of food. However, despite a huge amount of laboratory and clinical research, the relationship between sugar and caries is still poorly characterized. A major reason for this is the complexity of the problem, for the formation of caries involves multifactorial interactions such as nutrients and food components of diet, plaque bacteria, salivary flow and composition, minerals and fluoride status, genetics, age, and even the race of the individual (see also Chapter.66). The most common organism in dental plaque associated with caries is Streptococcus mutans, but other bacteria contribute. Most studies have focused on the acids (lactic and acetic) generated from sugars (sucrose) by the bacteria,...

The Art And Science Of Diagnosis

To be a good diagnostician a clinician must learn the fundamentals of gathering and interpreting clinical information. An inflamed or diseased pulp is a common, straightforward, and nonurgent condition. Systematic recording of a patient's presenting signs and symptoms and careful analysis of the findings from clinical tests inevitably lead to a correct diagnosis. There arc instances, however, when a patient presents with an acute situation, conflicting signs and symptoms, or inconsistent responses to clinical testing. Chapter 2 explores the methods for diagnosing and testing these endodontic riddles. Chapter 3 discusses the ostensible toothache of nonodontogenic origin.

Examination And Testing

Visual inspection of the teeth begins with drying the quadrant under examination and looking for caries, toothbrush abrasion (Fig. 1-1, D) (cervical lesions occasionally are overlooked), darkened teeth (Fig. 1-1, ), observable swelling (Fig. 1-1, F), fractured or cracked crowns (Fig. 1-1, G), and defective restorations.

Acceptance and Purchase

We do not know how many people with moderate-to-severe OSA avoid initial consultation with a sleep physician, or seek primary referral to surgeons or dentists, because they will not entertain even the possibility of using CPAP. The percentage of patients who refuse CPAP after an in-hospital trial is variable (89). CPAP purchase rates after PSG CPAP titration are over 50 , based on a calculation comparing new CPAP machine sales provided by manufacturers with national insurance data on multiple sleep study frequency (90). In other words, over 50 of patients completing a sleep laboratory trial end up purchasing a CPAP machine or having one purchased for them by the health system.

Project Title Animal Model Of Proliferative Verrucous Leukoplakia

Human papillomavirus (HPV) is the leading candidate for a role as a viral co-factor in oral cancer. In women, estrogen has been linked to multiple malignancies, including breast, cervical and uterine cancers, but, heretofore, estrogen has not been studied as a possible factor in oral cancer, despite the fact that well-recognized hyperplastic lesions of the oral cavity occur as a result of hormonal changes during pregnancy and puberty. We hypothesize that HPV and estrogen interact in the oral cavity to cause proliferative verrucous leukoplakia, an oral condition, seen predominantly in women, which is associated with a high prevalence of HPV infection and which ultimately eventuates in oral cancer. Interactions between HPV and estrogen in the pathogenesis of cervical cancer have been studied in a specific transgenic mouse model (K14-HPV16), in which a portion of the HPV16 genome is targeted to the progenitor compartment of the epithelium by means of the keratin 14 promoter....

Brief advice from health professionals

Randomized trials have clearly established the value of brief advice from general practitioners, dentists, and others to their smoking patients. (58) Such advice does not require specialist training, can be given in the doctor's own words, and need take no more than a few minutes of face-to-face contact. Its effect is to motivate more cessation attempts rather than to give any specific help in overcoming withdrawal. The Cochrane Collaboration estimates the increment in successful cessation from such interventions to be 2 per cent. While this may seem low, its value from a public health perspective is that it offers the possibility to reach the 70 per cent or more of smokers who consult a health professional each year.

Nonaccidental injury NAI

A small number of children arc victims of deliberate and, sometimes, systematic injury by their parent(s), or other adults involved in their care. Although orodental injuries are rarely the presenting problem, from time to time the child's first contact with a health care professional may be with the dentist. Approximately 30 of non-accidental injuries are to the face. For this reason all dentists caring for children should be aware of the possibility of non-accidental injury.

Introduction Of The Yellow Card Scheme

Many countries introduced systems for the systematic collection of reports of adverse drug reactions. In the United Kingdom, the Committee on Safety of Drugs (now the Committee on Safety of Medicines CSM) was set up. One of the responsibilities of this new committee was to collect and disseminate information relating to adverse effects of drugs (Griffin, 1992). To address this objective, the UK's spontaneous reporting scheme was introduced in 1964, when Sir Derrick Dunlop (the chairman of the Committee on Safety of Drugs) wrote to all doctors and dentists in the United Kingdom to announce the launch of the new Scheme (Griffin and Weber, 1992). In his milestone letter, Sir Derrick asked every member of the medical dental profession in the United Kingdom'' to report promptly details of any untoward condition in a patient which might be the result of drug treatment'' and stated that All the reports or replies that the Committee receive from doctors dentists will be treated with complete...

Factors associated with the injury

There is no evidence to support the statement that fractured teeth with larger exposures have a poorer prognosis. Indeed, in the related field of iatrogenic exposure arising during treatment for caries, no difference in outcome has been shown in relation to the size of the exposure. It has also been shown in traumati-cally induced pulp exposures, in primates, that the size of the exposure does not affect the ability of the pulp to form a satisfactory calcilic barrier beneath calcium hydroxide. Nevertheless, it is possible that the larger the exposure the greater the risk of bacterial contamination and the larger the blood clot on the pulp surface, both factors known to adversely influence healing (sec below). However, the idea that the size of the exposure is important is so (irmly entrenched that it will be a long time before the prevailing view changes. This is especially difficult to reconcile as the recommended treatment procedures frequently involve surgically increasing the size...

Clinical Evaluation and Management

An interdisciplinary, medical, and dental approach to diagnosis and management would appear to be conducive to good patient care. It is generally recommended that initial medical assessment and diagnosis precede the prescription and initiation of oral appliance therapy (20). Once the medical decision to proceed with oral appliance therapy has been made, it is recommended that the dental component be carried out by appropriately qualified and experienced dental practitioners (20). During the initial dental consultation the oral health status is assessed for suitability and informed consent is obtained. A lateral cephalometric X-ray may be advisable to evaluate airway continuity and dimensions as well as for baseline documentation of the position and angulation of the teeth. A regular alginate impression with buccal and palatal soft tissue features is required. The precision of the impression depends on the design of the splint. A construction bite in an initial 75 protrusive mandibular...

Clinical Classification

The pulp is inflamed to the extent that thermal stimuli cause a quick, sharp, hypersensitive response that subsides as soon as the stimulus is removed otherwise the tooth is asymptomatic. Any irritant that can affect the pulp may cause reversible pulpitis (e.g., caries, deep periodontal scaling and root planing, an unbased restoration). Treatment consists of placing a sedative dressing or packing containing zinc oxide and cugenol in or around the tooth. If the pulp can be protected from further thermal shock, it may revert to an uninflamed state. For example, removing all caries or a recent deep amalgam and placing a temporary restoration (e.g., Intermediate Restorative Material) in the cavity for several weeks should provide almost immediate relief. After several weeks the sedative dressing can be replaced with a well-based permanent restoration. Radiographs alone are of little assistance in diagnosing a symptomatic irreversible pulpitis. They are helpful in detecting suspect teeth...

Deciding what to drink

Amazingly, fluoride had been mainly used as insect and rat poison before being introduced to the American public water supply. Even if fluoride did prevent tooth decay, which is also highly debatable, there is no justification for the massive administration of such a toxic substance to so many people without their consent. For some reason, public water fluoridation is another political flashpoint for many people and politicians, with name-calling and finger-pointing always overwhelming any rational discussion or scientific review of the case against fluoride. But you have now been warned. Research the issues for yourself before you decide that fluoridated water just has to be beneficial.

Project Title Florida Model For Oral Cancer Control Phase I

Opinions, and the prevention and early detection activities of healthcare providers in Florida about these cancers (3) Assess the level of knowledge, opinions, and behaviors of a general population sample of adults in Florida regarding oral cancer (4) Assess the educational resources for health care providers in the state of Florida for oral cancer prevention and (5) Build an organizational infrastructure in Florida to facilitate community- based interventions for oral cancer prevention and control. We will use data from Florida's Cancer Data System and state vital statistics datasets to provide a detailed analysis of the incidence, mortality, survival, and stage distribution at time of diagnosis by age, sex, race, ethnicity, and geographic region. Principles of social marketing will be applied to assess the knowledge, attitudes, practices, facilitators, and barriers for oral cancer prevention among representative samples of Florida's general dentists, primary care physicians, nurse...

Project Title General Clinical Research Centerforsyth Dental Instit

Summary (provided by applicant) The BIDMC's GCRC proposes to form a satellite with the Forsyth Dental Institute (FDI), a world class center for clinical investigation of oral disease. This proposal describes a spectrum of investigations involving treatment of periodontal diseases, development of a vaccine for dental caries, testing of mercury amalgam toxicity and investigation of oral cancer. Sixteen projects are described that will be conducted at the Satellite Center that include microbiology, microbial genomics, microbial taxonomy, immunology and toxicology as these studies relate to conditions of oral health and disease and microbial biofilms. The proposed Satellite Center will include a Dental Clinic Core, a Laboratory Core and Biostatistics Informatics support. Specific areas of investigation in this application include 1) comparison of conventional and antibacterial_supplemented treatments of periodontal disease 2) investigation of means to prevent periodontal disease 3)...

Evidence For Sucrose Restriction In Diabetic Diets

Other nutritive calorie-containing sweeteners such as maltodextrins, corn syrup, fruit juice concentrate, honey, molasses, dextrose and maltose do not offer any advantage over sucrose in terms of energy content or glycaemic response. Indeed, post-prandial glycaemia is higher after maltodextrins and corn syrup than after sucrose. Sugar alcohols (sorbitol, mannitol, xylitol) and isomalt used as sweeteners in sugar-free confectionery produce a lower glycaemic response than sucrose and inhibit dental caries formation. Excessive consumption ( 20-30 g per day) should be avoided because of their laxative effect.

Prevention and Treatment

The most important method for controlling dental caries is restricting sucrose and other refined dietary carbohydrates, thereby reducing Streptococcus mutans colonization of teeth and acid production by cariogenic plaques. Dental caries can be reduced by 90 if sucrose-containing sweets are eliminated from the diet. It is not, however, simply the quantity of sugar in the diet that is important. The frequency of eating and the length of time food stays on the teeth is more critical than the actual quantity of sucrose ingested. Interestingly, chewing paraffin or sorbitol-sweetened gum reduces dental caries, probably because it increases the flow of saliva. Trace amounts of fluoride are required for teeth to resist the acid of cariogenic plaques. Fluoride makes tooth enamel harder and more resistant to dissolving in acid. In the United States, more than 100 million people are currently supplied by fluoridated public drinking water, which has resulted in a 60 reduction in dental caries. In...

Carbohydrates and Health

The mean annual consumption of sucrose plus fructose in developed countries is about 25 of the caloric intake. Fructose is more lipogenic than glucose. This high intake of sucrose (approximately 50 kg year person) has been contentiously implicated in influencing the health of humans, apart from caries, because a high consumption of sucrose fructose in experimental animals (often rats) creates, among other things, hyperlipidemia, insulin resistance, hypertension, and diabetic-like tissue lesions (66). However, while a hyperlipidemic effect of sucrose and fructose has been demonstrated in a number of human studies, firm conclusions cannot be made because of great variations in the type of subjects, duration of intake, background diet, and study conditions ( 66). The general conclusion of an FDA-sponsored survey published in 1986 was that the present voluntary intake of sucrose and fructose is not harmful to humans ( 67). A more recent review, while accepting that the intake of sucrose...

General Comments And Immunology

A rare and chemically inert metal similar to platinum, palladium occurs at such low concentrations in alloys (e.g., in jewelry or dental fillings) as to pose no notable toxicological hazard. No acute or systemic effects in humans have been reported, other than the observation of allergic sensitization, which can involve the respiratory system, skin, oral mucosa, and eyes, ascribed to contact with the metal itself. Acute contact dermatistis (ACD) and oral mucosal lesions, such as erosive lichen planus, are the principal clinical expression of palladium sensitivity seen in the general population, acquired mainly from the metal in alloys used in dental prostheses which can contain up to 79 of the metal (1,2). Rare cases of immediate type allergy have been reported (3-8). The prevalence of reactions to dental materials has been on the increase since the introduction of palladium-silver alloys in 1973 as a substitute for other materials containing metals suspected of toxicity or...

Managing Consumers Expectations Can Also Be Challenging

Sometimes promised results are so long in coming, or learning proper use is so time-consuming, that consumers give up. Products that take weeks or months to show their multifunctional benefits often are abandoned before the formulations have had a chance to achieve results. Countless bottles of skin care products rotate through consumers' cabinets as any subtle wrinkle or pore reduction goes unnoticed. People move on to the next possibility, hoping that it can work sooner, or even at all. Patience levels need to be queried in consumer research studies. Super-high-margin Rembrandt toothpaste succeeded in spite of itself because consumers perceived that, over time, it was working to whiten their teeth better than other toothpastes. Dentists, however, agreed that there was actually no superior benefit. Researchers need to determine the specifics about how the consumer thinks the MFP will perform, as well as to assess their levels of expectations.

Roles of Health Professionals

Physicians and pharmacists must take steps to prevent the two most common errors in prescribing and dispensing medications (1) giving an incorrect medication or dosage inappropriate for the patient's diagnosis and (2) giving a medication that will adversely interact with another medication the patient is taking. Although avoiding the first of these errors is primarily the responsibility of the physician, both physicians and pharmacists have been assigned the duty to avoid the second type of error. Discoveries in phar-macogenomics may give rise to a third potentially common medication error (3) giving a medication that is not indicated for the patient's genotype. It is not yet clear how the responsibility for avoiding these errors will be allocated, but it is quite likely that both physicians and pharmacists will be required to consider genetic information in prescribing and dispensing medications (see chapter by Brushwood, this volume). Dentists, nurses, and other health professionals...

Determining The Diagnosis

Firm whether pulpal pathosis is confined to the root canal space or has progressed and exhibits periapical extension. Specific etiologic factors such as caries, fracture, trauma, restorations, and other, more subtle, initiators of pulpal inflammation (developmental anomalies, orthodontic tooth movement, viral agents32) must also be identified. Probably the most common kind of nonurgent odontogenic pain is pain related to exposure of dentinal tubules to outside stimuli. As the physiology of this type of pain has been discussed previously, it is sufficient to describe the pain as very brief and sharp. Causes range from dentin exposure via caries to trauma of the dentin by enamel fracture. The overriding question for the clinician is whether the brief sharp pain is a normal response of a healthy pulp or a sign of pulpal inflammation. Protection and insulation (transdentinal therapy) of exposed dentin in a healthy pulp normally result in complete resolution of the dentinal symptoms. At...

Project Title New York State Oral Cancer Control Partnership

Summary (provided by applicant) Oral cancer is a significant problem in New York State. During the period 1993-1997, there was an annual average of 1889 cases of oral and pharyngeal cancers. Trends in morbidity and mortality show only a modest change in the past twenty years. The proportion of oral cancers diagnosed in early stages range from a low of 27 percent among black males to a high of 49 percent among white females. New York has a diverse population and more than 3 million adults are engaged in high-risk behaviors. The objectives of this proposal are to plan and develop an organizational infrastructure, conduct needs assessment, and guide the development of interventions for the prevention and early detection of oral cancer in New York State. We will develop a unique private-public partnership with representatives from many different organizations. A steering committee consisting of the State Health Department, New York University College of Dentistry (NYUCD), American Cancer...

Patientdoctor Dynamics

At the most simple and basic level, the patient who seeks care for a toothache may be suffering pain from puipal and periapical tissue inflammation. Other causes, however referred pain, more complex facial pain, temporomandibular joint (TMJ) pain, nonodontogenic pain in the head and neck demonstrate that the complaint of toothache is insufficient to diagnose and treat these entities. Patients' experience with successful or unsuccessful treatments invariably influences their behavior. Reassurance that the dentist can treat and eliminate acute dental pain efficiently helps to modulate anxiety and fear-related behavior. Personality and cultural factors are additional learned behaviors that can modify a patient's responses to pain and they should be considered in pain management. Disturbances of the pulpodentinal complex in a vital tooth initially affect the low-threshold A-deita fibers. Not all stimuli reach the excitation threshold and generate a pain response. Irritants such as...

Anticholinergic drugs

These agents have some preference for the central nervous system but some peripheral anticholinergic effects are to be expected. Blockade of vagal tone in the heart produces tachycardia. Other adverse effects include decreased bladder function and urinary retention and decreased bowel motility leading to constipation and impaction. Decreased saliva and bronchial secretion contribute to dry mouth and increased dental caries while decreased sweating increases the risk of heat stroke. Blockade of muscarinic receptors in the eye cause pupillary dilation and inhibition of accommodation, leading to photophobia and blurred vision. Rarely, narrow-angle glaucoma may ensue. The muscarinic receptors in the basal ganglia are predominantly M 2 whereas those in the periphery are M1. The rank order of the anticholinergic drugs for relative selectivity for the M 2 receptor is biperiden, procycliden, trihexylphenidyl, and benztropine. All these agents can cause dry mouth, blurred vision, urinary...

Poppers criticism of materialism

There is not only a causal relation from lower levels to higher levels but also vice versa a 'backward' causal relation from higher levels to lower levels. For example, scientific theories have deeply changed the physical world through their technological applications. Moreover, since science cannot act directly on the physical world such an interaction between the abstract objects of the World 3 and the material objects of the World 1 needs the mediation of the World 2, that is, the mediation of human beings. Therefore there are backward causal relations from the World 3 to the World 2 and from the World 2 to the World 1. For example, through mental processes human beings have conceived scientific theories and devised technological applications that have deeply modified the physical world (Popper & Eccles 1985 47-48). As for the mind-body problem, this means that mental acts can have effects on the physical world. For example, if you go to a dentist's because you have a toothache the...

Project Title Contrast Enhanced Spectroscopic Detection Of Oral Cancer

Are the hypotheses that spectral information from contrast-enhanced fluorescence images of oral lesions can be used as a reliable approach toward accurate and early non-invasive detection of pre-malignant and malignant lesions in the oral cavity. This revised proposal will focus on the development and testing of topical application of newly developed Lanthanide Chelate-based contrast agent to induce selective accumulation of a fluorescing dye in malignant transformed epithelial tissue for the purpose of early lesion detection. Our preliminary work has shown (1) promising correlation between the spectral information observed in contrast-enhanced fluorescence and pathological state of the lesion in the early stage of development, and (2) the ability of malignant oral lesions to selectively accumulate the contrast agent as compared to benign lesions or normal tissue. We propose to synthesize a new contrast agent that can be excited in the region of 3 10-330 nm and perform cellular and in...

United Kingdom

The MCA's post-licensing division, together with the Committee on Safety of Medicines, runs the Yellow Card'' scheme for the reporting of all suspected adverse drug reactions (the name of the scheme derives from the colour of the standardised reporting forms, see Appendix 8). Voluntary reports are accepted by the Committee on Safety of Medicines MCA from doctors, dentists, coroners and, since November 1999, community pharmacists. Reports are not accepted from members of the public. In addition, reports are received from marketing authorisation holders in accordance with their legal obligations. All reports

Risk factors

Previous infective endocarditis is a frequent risk factor, particularly in patients with cardiac disease, continued drug abuse, or dental decay. Intravenous drug abuse is commonly associated with the development of endocarditis in the younger patient. Central venous and pulmonary artery catheters, feeding lines, and intracardiac pacemakers present other risk factors, usually for right-sided endocarditis, if not quickly removed following infection ( Fig 3 and Fig 4).


Glycocalyx is used by a prokaryotic cell to protect it against attack from the body's immune system. This is the case with Streptococcus mutans, which is a bacterium that colonizes teeth and excretes acid that causes tooth decay. Normally the body's immune system would surround the bacterium and eventually kill it, but that doesn't happen with Streptococcus mutans. It has a glycocalyx capsule state, which prevents the Streptococcus mutans from being recognized as a foreign microorganism by the body's immune system. This results in cavities.

Followup Procedures

Once successful acclimatization is complete, and efficacy is verified, it is generally recommended that patients undergo dental review every six months for the first year, and yearly beyond that (20). This is to monitor clinical efficacy, adherence, oral health and occlusion, and device deterioration. Medical follow-up is required to assess the clinical response to treatment, usually with polysomnography or a portable monitoring device. Subsequent medical review is required to assess adherence and ongoing efficacy of the treatment. This may require periodic review with poly-somnography if there is concern about attenuation of efficacy.

Assay sensitivity

Assay sensitivity refers to the capacity of a study to show that the units of observation (e.g. patients, subjects, or plants for that matter) entered into that study are affected by the treatments applied. For Model and Houde, the proof of a study's assay sensitivity lies in its capacity to distinguish a test substance from an inert one, and different levels of the test substance from one another. These capacities, importantly, are not evaluated to confirm the fact that the drug being used as a standard control is an effective drug, but to ensure that the sample of patients admitted to the study have a capacity to respond to pharmacological treatments of the class being investigated. If such a precaution is not taken, one might mistakenly conclude from a failure to find a between-group difference in a comparative study of the analgesic effects of sugar water and morphine conducted in patients with mild dental pain that sugar water and morphine are equally potent analgesics.


Fluorides are widely used in caries prevention, for which they have been highly effective. Systemic administration of fluorides for caries prevention is available via drink Mild tooth staining has been observed after use of stannous fluoride products. The ADA Council on Dental Therapeutics endorses fluorides for their caries-inhibiting effect but not for plaque inhibition.

Components of Pain

For example, applying heat to the skin will cause the sensation of pain. However, the point beyond which pain becomes unbearable (pain tolerance) varies widely among individuals. Pain tolerance is also different for the same person depending on the circumstance in which sensation is detected. For example, a toothache might hurt more when you're home than at work where you have a lot of distractions from the pain.

Microcheck 241

The alimentary tract is a major route for pathogenic microorganisms to enter the body. People with poor saliva production risk severe tooth decay. Infections of the esophagus are so unusual in normal people that their occurrence suggests immunodeficiency. The stomach is responsible for acid digestion of food, the small intestine for alkaline digestion and absorption of nutrients. Undigested material becomes feces in the large intestine.

Microcheck 243

The pathogenesis of tooth decay depends on both dietary sucrose and acid-forming bacteria that are adapted to colonize hard, smooth surfaces within the A sucrose-rich diet is important in tooth decay, but figure 24.4 shows the effect of glucose. Are sucrose and glucose equivalent Why or why not

Fact and Fantasy

We reported two decades ago that biomolecules and molecular assemblages such as membranes and proteins can be stabilized in the dry state in the presence of a sugar found at high concentrations in many anhydrobiotic organisms, trehalose.1 We also showed that trehalose was clearly superior to other sugars in this regard.2 This effect seemed so clear it quickly led to wide-spread, and often uncritical, use of the sugar for preservation and other purposes. In fact, an array of applications for trehalose have been reported, ranging from stabilization of vaccines and liposomes to hypothermic storage of human organs.3 Other workers showed that it might even be efficacious in treatment of dry eye syndrome or dry skin in humans.4'5 Trehalose is prominendy listed as an ingredient in cosmetics, apparendy because it is reputed to inhibit oxidation of certain fatty acids in vitro that might be related to body odor.6 Trehalose has been shown by several groups to suppress free radical damage,...


The majority of TN (80-90 ) is caused by compression of the nerve in the root entry zone by a blood vessel (usually the superior cerebellar artery) or by a space-occupying lesion. Because of the possibility of a space-occupying lesion, patients should have an MRI scan as part of their initial assessment. Patients should also be questioned directly about any episodes of visual disturbance, weakness, sensory and bladder disturbance, as a small percentage of patients have a demyelinating condition as the cause of their neuralgia. It is also important to exclude any dental problems that the patient may have, as dental pain may mimic TN.

Health needs

Signs of poor physical care among elderly people with mental retardation (e.g. blepharitis, pressure sores, or tooth decay) may indicate a deterioration in their functioning, but may also indicate that carers are not coping, and this emphasizes the necessity to ensure access to primary care. Many health issues, such as visual and hearing impairment, can be easily and quickly corrected, leading to significant health gain. Overall, uptake of services by elderly people with mental retardation is poor. (31)

Oral Dysfunction

It is generally perceived that individuals with PD are prone to develop dental dysfunction.44-47 Difficulty with the repetitive motions necessary for teeth brushing, pooling of saliva in the mouth, or (alternatively) dry mouth, jaw muscle rigidity, difficulty retaining dentures, and involuntary jaw movements are problems that may be encountered by the person with PD.48-50 The propensity of patients with PD to have a penchant for sweets has also led to concerns that this might promote dental decay, although such confectionary consumption does not seem to alter the oral microflora.51

Dental History

Chief Complaint Example

Because dental pain frequently is the result of a diseased pulp, it is one of the most common symptoms a dentist is required to diagnose.14 The source of the pain is usually made evident by dental history, inspection, examination, and testing. However, because pain has psychobiologic components At times pain is referred to other areas within, and even beyond, the mouth. Most commonly it is manifested in other teeth in the same or the opposing quadrant. It almost never crosses the midline of the head. However, referred pain is not necessarily limited to other teeth. It may, for example, be ipsi-laterally referred to the preauricular area, or down the neck, or up to the temporal area. In these instances the source of cxtraorally referred pain almost invariably is a posterior tooth. Ostensible toothache of nonodontogenic origin (i.e., resulting from neurologic, cardiac, vascular, malignant, or sinus diseases) is described in Chapter 3. Patients may report that their dental pain is...

Figure 422

Although chlorhexidine affects virtually all bacteria, gram-positive bacteria are more susceptible than are gram-negative organisms. Furthermore, Streptococcus mutans and Antinomies viscosus seem to be particularly sensitive. S. mutans has been associated with the formation of carious lesions in fissures and on interproximal tooth surfaces and has been identified in large numbers in plaque and saliva samples of subjects with high caries activity.

And Herpes Zoster

Herpes Zoster Ophthalmicus Cornea

Herpes zoster (shingles) is due to reactivation of the Varicella zoster virus. In the orofacial region it is characterised by pain, a vesicular rash and stomatitis in the related dermatome. Unlike herpes labia-lis, repeated recurrences of zoster are very rare. Occasionally there is an underlying immunodeficiency. Herpes zoster is a hazard in organ transplant patients and can be an early complication of haematolymphoid neoplasms and HIV infections. Herpes zoster usually affects adults of middle age or older, but occasionally involves children. The first signs are often pain, irritation or tenderness in one or more divisions of the trigeminal nerve. The pain may be severe and can be misinterpreted as toothache, leading to inappropriate dental intervention. Malaise and low-grade fever are common constitutional symptoms. There is usually a strikingly unilateral, vesicular exanthem restricted to the affected dermatome. Intraorally, there may also be extensive unilateral ulceration in the...


The role of saliva is to moisten and protect oral and pharyngeal mucosa, lubricate, transmit taste information, buffer chemicals, initiate carbohydrate digestion, act as an antimicrobial agent, prevent dental caries, and participate in enamel formation (10,11). The oral cavity houses three major paired salivary glands parotid, submandibular (submaxillary), and sublingual and hundreds of minor salivary glands. The minor salivary glands are primarily located in the buccal, labial, palatal, and lingual regions, but are also found at the superior pole of the tonsils, tonsillar pillars, and base of the tongue (10). Together, the major and minor salivary glands produce 1000-1500 mL of saliva per day, equivalent to an average salivary flow rate of 1 mL min, depending on salivary gland stimulation (12). Each gland at rest secretes at a rate of 0.001-0.2mL min, and secretion increases to 0.18-1.7mL min when the glands are stimulated (10). The gland distribution of salivary production also...

M J Tenerelli

There was a time when toothpaste cleaned your teeth and mouthwash freshened your breath, and that was that. Not anymore. Today, oral care products promise at least two, if not three or four, different ways to bolster your oral health and beautify your face. Toothpastes that clean also battle gum disease and turn pearly whites whiter. Mouthwash fights plaque as well as halitosis. These innovations in oral care products are a direct response to the busy modern consumer, who wants one product to do effectively as many things as possible. While toothpastes and mouthwash share some basic ingredients, the special extra functions they endeavor to provide call for different and specific ingredients for each formulation.

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